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California is among 48 states reporting widespread flu activity.

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Despite a severe vaccine shortage, Alameda and Contra Costa counties will hold free swine flu clinics beginning Saturday, but will sharply restrict who is eligible for the coveted shots.

Nearly 31.8 million doses of vaccine against the H1N1 virus, or swine flu, are available nationwide. Millions more doses are expected in coming weeks.

The vaccine is arriving much slower than most health officials had anticipated, especially since 48 states, including California, now have widespread flu activity and people are clamoring for protection.

A clinic in Pleasanton last week drew 373 vaccine-seekers.

Solano County immunized more than 1,200 people at a Benicia clinic Friday and turned dozens away when the supply ran out.

"We have used all of the vaccine that we've been given," said Robin Cox, Solano County health education manager, earlier this week. The county will not schedule more clinics until it learns when new shipments will arrive, she said.

"We really don't want to advertise clinics and have people show up and then have to cancel them," Cox said. "It's frustrating enough as it is."

Counties vary widely in the number of doses they have received, adding to the confusion and angst.

Contra Costa County has obtained 80,000 doses, more than many neighboring counties. But that represents "a significant shortage" based on the need, said Dr. Wendel Brunner, the county public health director.

"We do know that there

The county had originally planned to hold a drive-through clinic Saturday at Hilltop Mall in Richmond, but has changed it to a walk-in clinic because of concerns that a crowd of motorists could jam traffic. Several thousand doses will be available for those in the priority groups, Brunner said.

Contra Costa County has just about concluded holding clinics at 50 low-income elementary schools. Health officials will return to those schools in the next few weeks since children under 10 require two swine flu vaccinations to develop immunity.

Alameda County health department spokeswoman Vanessa Cordova declined to reveal how much vaccine her department has received. But she said more than 80 percent of the shipments have gone to private providers, hospitals and community clinics.

The county has targeted its upcoming clinics for the uninsured because they may have no other access to the vaccine, Cordova said.

Honor system

People who show up at both the Alameda and Contra Costa County clinics on Saturday will be on the honor system to reveal whether they fall within the priority

"We're calling on everyone's civic duty to acknowledge there is a segment of the population that gets very, very sick," Cordova said.

Because of the vaccine shortage, both counties have set stricter priorities than initially established by the federal Centers for Disease Control and Prevention. Children have been among those hardest hit hardest by swine flu, so the counties are excluding most adults until vaccine supplies expand. The exceptions are pregnant women and caregivers of newborns.

Nationwide, at least 114 children have died. Two-thirds of them had underlying health conditions.

San Mateo County will not schedule clinics until the vaccine supply expands, spokeswoman Robyn Thaw said. Private providers typically distribute more than 95 percent of its flu vaccine, she noted.

Universities, which have been hit hard by the H1N1 virus in other states, have had a difficult time getting vaccines to their student health centers in California. As of Friday, six University of California campuses and one UC medical center had no vaccine.

UC Berkeley had requested 70,000 doses, but received 30.

"The H1N1 vaccine is trickling in at best at the medical centers and it's almost nonexistent at campuses," said Grace Crickette, UC's chief risk officer, in a written statement. "Our expectation is that the public health departments will give us some, but it's going to be limited and sporadic."

Moving fast

Health officials are rushing to get vaccine out as it arrives because although this is early for a typical flu season, the H1N1 virus is circulating widely in the East Bay.

It caused a big increase in hospitalizations in October, Brunner noted, and came close to reaching peaks experienced last spring.

"Virtually all the flu we're diagnosing is still H1N1," CDC director Tom Frieden said during a conference call with reporters this week. "So almost no seasonal flu yet. What the rest of the season will hold, only time will tell."

Frieden and local county officials urge people to contact their private health care providers about vaccine because many will be getting their own supplies, and to keep checking back if it is not yet available.

"We ask people to continue to be persistent," Frieden said.

On a positive note, the virus does not appear to have mutated to a form that would cause more severe illness. That also means that the vaccine, when people can get it, should provide optimum protection.

Staff writer Matt Krupnick contributed to this story. Reach Sandy Kleffman at 925-943-8249.